Laparoscopic pyeloplasty with concomitant pyelolithotomy--is it an effective mode of treatment?

Abstract

Introduction: Pelviureteric junction (PUJ) obstruction and concomitant renal calculus disease may coexist. We present our experience with simultaneous laparoscopic pyeloplasty and pyelolithotomy in such patients.

Method: 20 patients (20 renal units) underwent transperitoneal laparoscopic pyeloplasty and concomitant pyelolithotomy at our institution. An initial dismembering of the PUJ followed by removal of the calculi with rigid or semi-rigid graspers were done. Calyceal stones were removed with the aid of a flexible cystoscope, rigid/flexible ureteroscope and simultaneous fluoroscopy. The pyeloplasty was subsequently performed in all cases.

Result: A median of 2 stones (range 1-12) were recovered from the 20 renal units. Complete stone clearance was possible in 15/20 patients (75%). Three patients underwent subsequent extracorporeal shock-wave lithotripsy and 2 required percutaneous nephrolithotomy. All patients were rendered stone-free at 6 months' follow-up. Diuretic renography at follow-up revealed improved drainage in 18/20 (90%) patients; 2 patients had an equivocal drainage pattern but their symptoms disappeared.

Conclusion: Laparoscopic pyeloplasty with concomitant pyeloplasty is feasible and effective, however patients must be counseled about the possibilities of ancillary procedures to achieve complete stone clearance.